Information
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Document No.
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Client
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Project
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Location
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On-Site Personnel (crafts)
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Today's Work Assignment
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Conducted on
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Prepared by
DESCRIBE SPECIFIC WORK TASKS TODAY
1. SAFETY ITEMS REVIEWED
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Respirators
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Fall Protection
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Powder Actuated Tools
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Aerial Lifts
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Ladders
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Scaffold
2. IDENTIFIED HAZARDS
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Burns Chemical / Thermal
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Eye
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Overexertion
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Elevated Load
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Falls Greater Than 6'
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Overhead Work
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Electrical Shock
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Pinch Points
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Lead / Asbestos / Silica
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Sprains / Strains
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Falling Material
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Utilities (Overhead / Underground)
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Trips / Slips / Falls
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Fire
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Abrasions / Cuts
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Cave In
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Weather Hot / Cold
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Moving Machinery
3. HAZARD ELIMINATION (Equipment Needed)
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Gloves / Apron / Leathers
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Inspection Tools / Rigging
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Ladders Tied Off
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Scaffold
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Face Shield / Goggles
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Respirators / Dust Masks
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Keep Picked Up
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Fire Watch / Extinguishers
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Guardrails
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Mast Climbers
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Fall Protection
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Tool Guards
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Hearing Protection
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Barricades
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GFCI
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Proper Slope / Trench Shield
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Toeboards / Netting
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Proper Lighting
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Swing Stage
4. OTHER GENERAL SITE SAFETY ISSUES REVIEWED / EQUIPMENT CHECKED
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Describe specific Issues:
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Activities coordinated w/ other companies
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Proper safety equipment provided
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Proper signage placed
5. ENGINEERING CONTROLS
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Infectious Control Barricades Inspected
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HEPA / Air Scrubbers In Place / Running
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HEPA / Air Scrubbers Filters Changed Periodically
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Tac-Mat Contaminate Control In Place
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Magnehelics Differential Pressure Gauge In Place
6. ATTENDANCE
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Signatures:
